Kosovo: Aid under siege
once again

20 October 1999

In the face of brutal state-planned crimes against humanity inside Kosovo, MSF confronted NATO's direct involvement in humanitarian action, an uncertain role for UNHCR, the lack of humanitarian protection inside Kosovo, and the relationship of NGOs to state funders who were at war. These were key questions in a political and military crisis where humanitarian action was essentially apart of military and political strategy. It was against these challenges, and toward the primary challenge of acknowledging and restoring the dignity of people and relieving the suffering of war, that MSF tried to steer a course through the Kosovo crisis.
MSF has had extensive on-the-ground involvement in the Kosovo region since 1993. In Kosovo itself, systematic attacks and massacres against civilians were clearly evident since the attack by Serb special police units in Drenica early in 1998. Kosovo Liberation Army (KLA) attacks also occurred through 1998 and 1999, and over 200,000 civilians were displaced inside Kosovo during this period.
In October 1998 MSF spoke out against the deplorable conditions that internally displaced persons had to endure, and the beating and killings of ethnic Albanian doctors working with us in Kosovo. With the failure of the Rambouillet talks in mid-March 1999, and as the Milosevic government amassed thousands of military and paramilitary personnel at the Kosovo frontier, monitors from the Organanisation for Security and Cooperation in Europe (OSCE) were pulled out of Kosovo on 20 March.
As Milosevic's forces escalated further attacks on Ethnic Albanian villages in Kosovo, without UN Security Council approval, NATO began a bombing campaign on 24 March designed ostensibly to bring Mr. Milosevic back to the bargaining table. The bombing action then, was not a UN intervention, but an intervention of NATO and its member states.
As violence and insecurity escalated, it became impossible to provide humanitarian assistance or protection, and on 29 March MSF was forced to withdraw its last remaining expatriate staff from inside Kosovo. With the onset of NATO bombing, Mr. Milosevic only accelerated his campaign of systematic terror and forced migration, and as the bombing campaign itself intensified, over an eleven week period more than 800,000 people were forcibly expelled from Kosovo.
Within days of the bombing, MSF had teams in Macedonia, Albania and Montenegro providing humanitarian assistance for the largest and fastest efflux of refugees in Europe since the Second World War. For those making it across the border, the most common medical issue was physical exhaustion and psychological trauma due the inhuman campaign of brutality that people had endured in Kosovo. MSF quickly provided direct medical care, established mental health programs, and provided shelter, water, sanitation, and epidemic monitoring in the region.
But the humanitarian effort during what is now called the Kosovo crisis was not just about technical service to meet the immediate physical needs of refugees. While the 800,000 refugees certainly had needs, those people who remained trapped and brutalized inside Kosovo were completely without humanitarian protection.
During the crisis, NATO member states - the richest states in the world and the traditional financial and political supporters of the UNHCR- shifted their attention and resources to direct political and military action in the region, effectively sidelining the UNHCR as the lead UN humanitarian agency. Effective registration of refugees - a fundamental first step to protecting their political rights as refugees - became all but impossible. As the lead UN Agency in this setting, UNHCR had the legitimate responsibility of setting humanitarian priorities around assistance and protection, and ensuring that these are implemented. Here, MSF lobbied internationally, insisting that UNHCR not be side-lined by the political and military interests of NATO and its member states.
Within days of bombing Kosovo and Serbia, NATO and its member states gave logistical support toward the humanitarian effort. Given the size and speed of the humanitarian need, this was necessary- as in many other circumstances this decade- but risked extending to a defacto control of independent and impartial humanitarian efforts. Seeing the public relations advantage toward their home-publics, NATO and its member states began building refugee camps in the region. Either directly or in collaboration with NGOs, they also wanted to manage those camps. Yet despite the disproportionate financial cost to NATO, in Albania for example, only a small proportion of refugees were actually housed in NATO-built camps. The vast majority were accommodated privately in the homes of Albanians, or scattered throughout the country in make-shift camps and collection centers.
By assuming a so-called humanitarian role, NATO was trying to improve its public image. However, not only did NATO violate fundamental humanitarian principles, many of its actions were incorrect, so that in some cases sites were poorly selected, and camp-layout and water and sanitation services had to be re-done according to correct UNHCR standards.
MSF refused to collaborate with NATO or its member states on refugee camp management, and unequivocally refused funding from NATO member states. Why? Because as actual parties at war in the conflict, they could not be seen as impartial supporters of humanitarian action, and collaboration of this kind could put the security of refugees at risk. This was born out when Serbian forces began shelling into Albania in regions where camps had been set up. Early on and repeatedly in the crisis, MSF publicly called on NATO to not mix military and humanitarian objectives and principles.
As the bombing campaign intensified, NATO's public relations increasingly focused on the work NATO was doing outside Kosovo for the refugees. In contradiction to this, MSF systematically surveyed and publicly released the stories of people leaving Kosovo; their experiences of rape, massacre and torture, and the beaten, killed, abandoned or lost family members remaining behind. In one survey conducted in Montenegro at the end of April, 28% of refugees had left at least one member behind in Kosovo, and 10% had wounded, killed or missing family members. At the height of the bombing and NATO's public relations campaign, MSF publicly called attention to the 'forgotten' people still inside Kosovo in the hands of the Milosevic government- those without humanitarian protection or assistance.
The actions of MSF aid workers and hundreds of national staff in the region provided direct medical assistance to people in need. Just as importantly, MSF also took strong public positions and lobbied internationally to demand humanitarian protection of people in Kosovo; to ensure access to refugees; for improved conditions for Kosovars displaced to Macedonia or seeking refuge in other neighboring states; for people's right to protection and political asylum, and for their right to not have to suffer the further indignity of being forcibly expatriated to a third country of asylum against their will.
By the end of June 1999, the Kosovo crisis was not over simply because the NATO campaign had ended, or because the refugees returned to Kosovo. By June, the majority of ethnic Albanian refugees had returned. Despite the presence of thousands of UN mandated troops, retribution-killings of Kosovar Serbs began, and tens of thousands of Serbs left Kosovo by the end of June. The crisis in the region continues into an uncertain future. With the massive reconstruction effort under way inside Kosovo, and the political uncertainly of the region, MSF continues to be present providing mental health programs, direct medical assistance and infra-structural rehabilitation, water and sanitation, epidemic monitoring, and of course, monitoring the humanitarian situation for both ethnic Albanians and Serbs.
For some, NATO's humanitarian war signaled the "the end of humanitarianism". However, as with Somalia, Rwanda, the former Yugoslavia and other conflicts around the world, for MSF Kosovo can only be yet "another chapter" in the struggle to preserve and assert the right to independent and impartial humanitarian action. Kosovo was and remains a monumental challenge to humanitarianism as we know it. In such settings, humanitarianism is not about political or military victories, but about relieving the human suffering of war, and acknowledging and acting to respect basic human dignity in the face of political failure and uncertainty. For MSF, beyond media or Western political interest, this was and is the challenge of humanitarianism both in Kosovo and around the world.